decisionhealth Newsletters, Answer Books - 2009 Issue 2 (February)
OIG Investigation Procedures / Investigation of Servicess Not Provided as Claimed / Elements of Offense
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Article Overview
This article covers a short compliance and enforcement topic focused on OIG investigation procedures for services not provided as claimed. It is relevant to auditors, compliance staff, investigators, and billing professionals who need to understand the general framework used in civil money penalty cases and claim review under Medicare and Medicaid oversight.
Why This Topic Matters
It helps readers identify whether a claim-level compliance issue may fall within OIG investigative and civil penalty processes, especially when services, filing instructions, or payer rules are implicated.
What You Will Learn
- How OIG investigation procedures relate to claim-based compliance matters.
- What broad elements are involved in a civil money penalty case.
- How Medicare and Medicaid claim-filing rules factor into enforcement review.
- The role of payer instructions and regulations in claim allegation analysis.
Who Should Read This
- Compliance officers
- Medical auditors
- Billing professionals
- Health care administrators
- Investigators
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